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If Benjamin Rush had known as much about statins and antibiotics as he did about bleeding and purging, perhaps we would see reference to health care in the Constitution. So alongside freedom of speech and freedom of the press we might see freedom to practice medicine, and freedom to elect medical treatment, similarly enshrined.

But we missed that chance, and now we seem on the brink of handing over a greater share of our health and health care to an ever-increasing federal overseer. Strange as it seems to me, I understand most people do not equate medical care with freedom. But wait until a greater slice of the health care budget is controlled by Washington, D.C., and then wonder where your freedom went. And you might also contemplate how much power is concentrated in the hands of a few  who will now be loath to relinquish that hold.

As the narrative for change unfolds in the days and months ahead, nowhere will the potential for affecting our lives be greater than in the health care arena. So it is no surprise that we are seeing a number of new and recycled proposals offered for discussion. Since the Democrats consolidated their hold on Washington in the past election, it is appropriate that Democratic proposals predominate. But the lack of Republican or market-based reforms is both incongruous and inexcusable.

During the recently concluded presidential campaign, I served as a surrogate for Sen. John McCain (R-Ariz.), debating my counterparts in the Obama campaign on health care. As a consequence, I know the McCain proposal well, and I also know well what was proposed by the other side. Three components of the McCain plan continue to be discussed: the tax treatment of employer-sponsored insurance, coverage for pre-existing
conditions, and insurance reform to open the market to true competitive influences.

Each of these has merit, and I have encouraged McCain to continue to offer his vision for extending coverage to more Americans without expanding the rapidly growing size and scope of the federal government. In fact, an independent study by the Lewin Group estimates a McCain plan would increase private coverage by 26.5 million people. In stark contrast, President-elect Barack Obamas plan will expand the number of Americans on government health care plans by 48.3 million.

As it stands, McCains is the only offering from our side. From the other side, there is no shortage of proposals. But why not a proposal focused on taking care of patients instead of favoring expanded government? Why not a proposal that encourages innovation rather than the status quo? And why not a system that rewards desired behavior/outcomes rather than always seeking to control costs by limiting access, or supply, or overtly rationing?

Former Speaker Newt Gingrich (R-Ga.), writing in Stanford Medicine this fall, wisely observed that most of the key breakthroughs we need in health are not a function of money. They are a function of focusing on new areas of health, and organizing and paying for better outcomes.

As an example, this past fall, on a visit to a neonatal intensive care unit in Fort Worth, Texas, I was startled by how quiet it was. The nurse manager, as if interpreting my surprise, said they use very few ventilators today, most of their babies being treated with a type of continuous positive airway pressure known as bubble CPAP. The cost of therapy has dramatically declined, serious long-term complications and disability are reduced, and the more serene atmosphere promotes better mother-infant bonding. This remarkable achievement occurred not because the federal government rationed the number of ventilators, not because the federal government determined that lung complications would no longer be reimbursed, but because an anesthesiologist had the curiosity to investigate what he had observed in adult patients and began to explore the possibilities in premature newborns.

It is disturbing to me that all the proposals are coming from the Democrats. It is an axiom of politics that it is hard to beat something with nothing. Or as Texas oilman T. Boone Pickens more colorfully puts it: A fool with a plan beats a genius without one almost every time.

Republicans must now realize they must offer more than just say no to greater governmental control of health care. We must offer principled, pragmatic, workable solutions, recognizing there will be individual, public and private sector involvement as a necessity.

If anything, the stakes are even higher now with the economic challenges ahead of us. Where we were previously concerned about controlling spending and future deficits, we are now entering a time of massively expanding deficits as a type of economic development tool.

And if federal deficits are of no consequence as some in Democratic leadership and some voices within the future administration say, then maybe we should take the opportunity to fix the flawed Sustainable Growth Rate formula in Medicare so our physicians are offered a more realistic reimbursement schedule that actually reflects the cost of delivering the care.

Perhaps also, in this time of change, we could designate physicians participating in Medicare, a federal health care program, to be given liability protection under the Federal Tort Claims Act, which would reduce the cost of providing care.

Suffice it to say that Republicans are not likely to win any votes in committee or on the House floor. We will have to be strategic as well as organized with an effective communications template to take our case to the American people directly.

If we are consistent in that effort, well, the next election is less than two years away.

House Republican Policy Committee Vice Chairman Michael Burgess (R-Texas) is a member of the Energy and Commerce Subcommittee on Health. He is an ob-gyn.